Healthcare Provider Details

I. General information

NPI: 1508911256
Provider Name (Legal Business Name): BROWNSBORO DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 BROWNSBORO RD SUITE 206
LOUISVILLE KY
40222-6374
US

IV. Provider business mailing address

4938 BROWNSBORO RD SUITE 206
LOUISVILLE KY
40222-6374
US

V. Phone/Fax

Practice location:
  • Phone: 502-339-2922
  • Fax: 502-339-2912
Mailing address:
  • Phone: 502-339-2922
  • Fax: 502-339-2912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number26744
License Number StateKY

VIII. Authorized Official

Name: MRS. KAREN J MOSGROVE
Title or Position: OFFICE MANAGER
Credential:
Phone: 502-339-2922